Pressure Points Bleeding can often be temporarily controlled by
applying hand pressure to the appropriate pressure
point. A pressure point is the spot where
the main artery to an injured part lies
near the skin surface and over a bone.
Apply pressure at this point with the
fingers (digital pressure) or with the heel of the hand.
No first aid materials are required. The
object of the pressure is to compress
the artery against the bone, thus
shutting off the flow of blood from the heart to the
wound.

There are 11 principal points on each side of the
body where hand or finger pressure can be used to stop
hemorrhage. These points are shown in figure
4-27. If bleeding occurs on the face
below the level of the eyes, apply
pressure to the point on the mandible. This is
shown in figure 4-27A. To find this pressure point,
start at the angle of the jaw and run your
finger forward along the lower edge of
the mandible until you feel a small
notch. The pressure point is in this notch.

If bleeding is in the shoulder or in the upper part of
the arm, apply pressure with the fingers
behind the clavicle. You can press down
against the first rib or forward
against the clavicle; either kind of pressure
will stop the bleeding. This pressure point is shown in
figure 4-27B.

Bleeding between the middle of the upper arm and
the elbow should be controlled by applying digital
pressure to the inner (body) side of the
arm, about halfway between the shoulder
and the elbow. This compresses the
artery against the bone of the arm. The
application of pressure at this point is shown in figure
4-27C. Bleeding from the hand can be
controlled by pressure at the wrist, as
shown in figure 4-27D. If it is
possible to hold the arm up in the air, the bleeding will
be relatively easy to stop.

Figure 4-27E shows how to apply digital pressure
in the middle of the groin to control bleeding from the
thigh. The artery at this point lies over a
bone and quite close to the surface, so
pressure with your fingers may be
sufficient to stop the bleeding.

Figure 4-27F shows the proper position for
controlling bleeding from the foot. As in the case of
bleeding from the hand, elevation is helpful
in controlling the bleeding.

If bleeding is in the region of the temple or the
scalp, use your finger to compress the main artery to
the temple against the skull bone at the
pressure point just in front of the
ear. Figure 4-27G shows the proper
position.

If the neck is bleeding, apply pressure below the
wound, just in front of the prominent neck muscle.
Press inward and slightly backward,
compressing the main artery of that
side of the neck against the bones of
the spinal column. The application of pressure at this
point is shown in figure 4-27H. Do not apply
pressure at this point unless it is
absolutely essential, since there is a
great danger of pressing on the windpipe, thereby
choking the victim.

Bleeding from the lower arm can be controlled by
applying pressure at the elbow, as shown in figure
4-27I.

As mentioned before, bleeding in the upper part of
the thigh can sometimes be controlled by applying
style="mso-spacerun: yes"> digital pressure in the middle of the groin,
as shown in figure 4-27E. Sometimes,
however, it is more effective to use
the pressure point of the upper thigh, as shown in
figure 4-27J. If you use this point, apply pressure with

Figure 4-27.-Pressure points.

the closed fist of one hand and use the other hand to
give additional pressure. The artery at this point is
deeply buried in some of the heaviest muscle
tissue in the body, so a great deal of
pressure must be exerted to compress
the artery against the bone.

Bleeding between the knee and the foot may be
controlled by firm pressure at the knee. If pressure at
the side of the knee does not stop the
bleeding, hold the front of the knee
with one hand and thrust your fist hard
against the artery behind the knee, as shown in figure
4-27K. If necessary, you can place a folded
compress or bandage behind the knee,
bend the leg back, and hold it in place
by a firm bandage. This is a most
effective way of controlling bleeding, but it is so
uncomfortable for the victim that it should
be used only as a last resort.

You should memorize these pressure points so that
you will know immediately which point to use for
controlling hemorrhage from a particular
part of the body. Remember, the correct
pressure point is that which is (1) nearest
the wound, and (2) between the
wound and the main part of the body.

It is very tiring to apply digital pressure, and it can
seldom be maintained for more than 15
minutes. Pressure points are
recommended for use while direct
pressure is being applied to a serious wound by a
second rescuer. Using the pressure-point
technique is also advised after a
compress, bandage, or dressing has been
applied to the wound, since this method will slow
the flow of blood to the area, thus giving the direct
pressure technique a better chance to stop
the hemorrhage. The pressure-point
system is also recommended as a stopgap
measure until a pressure dressing or a
tourniquet can be applied.

Elevation The elevation of an extremity, where appropriate,
can be an effective aid in hemorrhage control when
used in conjunction with other methods of
control, especially direct pressure.
This is because the amount of blood
entering the extremity is decreased by the
uphill gravitational effect. Do not elevate an extremity
until it is certain that no bones have been
broken or until broken bones are
properly splinted.

Splints Another effective method of hemorrhage control
in cases of bone fractures is splinting. The
immobilization of sharp bone ends reduces
further tissue trauma and allows
lacerated blood vessels to clot. In
addition, the gentle pressure exerted by the
splint helps the clotting process by giving additional
support to compresses or dressings already
in place over open fracture sites.

Later in this chapter we will go into the subject of
splinting in greater detail.